Ojagbemi Akin, Bello Toyin, Elugbadebo Olufisayo, Owolabi Mayowa, Baiyewu Olusegun
World Health Organization (WHO) Collaborating centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine, University of Ibadan; Department of Psychiatry, College of Medicine University of Ibadan, Nigeria.
World Health Organization (WHO) Collaborating centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine, University of Ibadan.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105251. doi: 10.1016/j.jstrokecerebrovasdis.2020.105251. Epub 2020 Aug 25.
Very little is known about the outcomes of poststroke delirium in relation to its symptom spectrum. We investigated the 3-months cognitive and functional outcomes of attenuated (ADS) and full delirium syndromes in Nigerian survivors of first ever stroke.
A prospective observational study with repeated assessments conducted in the first week of stroke using the confusion assessment method. Full delirium was diagnosed according to criteria in the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-V). ADS was characterised in survivors who were free of full, but had ≥two core features of, delirium. Baseline and follow-up assessments were conducted using the Mini-Mental state examination (MMSE), 10-words list learning and delayed recall test, Animal naming test and Barthel index.
Among 150 participants, ADS was present in 32 (21.3%), full delirium in 29 (19.3%). In linear regression analyses adjusting for age, economic status and systemic hypertension, ADS [(Mean difference (MD) = -3.8, 95% C.I = -7.0, -0.7)] and full delirium (MD = -5.6, 95% C.I = -9.0, -2.1) independently predicted poorer global cognitive functioning at follow-up. Significant declines in memory (MD = -1.9, 95% C.I = -2.8, 0.9), executive (MD = -2.2, 95% C.I = -4.1, -0.3) and physical functioning (MD = -2.8, 95% C.I = -5.5, -0.2), as well as a 4-fold increase in the independent odds (O.R) for dementia (O.R = 4.1, 95% C.I = 1.0,16.1) were also recorded in full, but not attenuated, delirium.
Attenuated and full delirium are associated with graded risk of poststroke cognitive decline. Reconsideration of poststroke delirium as a spectrum, rather than threshold-based categorical diagnosis will improve detection and prioritization of stroke survivors at increased risk of cognitive decline.
关于卒中后谵妄的症状谱及其预后知之甚少。我们调查了尼日利亚首次卒中幸存者中轻度谵妄综合征（ADS）和完全谵妄综合征的3个月认知和功能预后。
一项前瞻性观察性研究，在卒中后第一周采用意识模糊评估法进行重复评估。根据《精神疾病诊断与统计手册》（DSM-V）第五版的标准诊断完全谵妄。ADS的特征是幸存者没有完全谵妄，但有≥两种谵妄的核心特征。使用简易精神状态检查表（MMSE）、10词列表学习和延迟回忆测试、动物命名测试和巴氏指数进行基线和随访评估。
在150名参与者中，32人（21.3%）存在ADS，29人（19.3%）存在完全谵妄。在对年龄、经济状况和系统性高血压进行校正的线性回归分析中，ADS[平均差异（MD）=-3.8，95%置信区间（C.I）=-7.0，-0.7]和完全谵妄（MD=-5.6，95% C.I=-9.0，-2.1）独立预测随访时较差的整体认知功能。完全谵妄组而非轻度谵妄组在记忆（MD=-1.9，95% C.I=-2.8，0.9）、执行功能（MD=-2.2，95% C.I=-4.1，-0.3）和身体功能（MD=-2.8，95% C.I=-5.5，-0.2）方面也有显著下降，以及痴呆的独立比值比（O.R）增加4倍（O.R=4.1，95% C.I=1.0，16.1）。
轻度和完全谵妄与卒中后认知下降的分级风险相关。将卒中后谵妄重新视为一个连续谱，而非基于阈值的分类诊断，将改善对认知下降风险增加的卒中幸存者的检测和优先级排序。
